Neurosurgery Coding Alert

Question: How do we report when our surgeon does an endoscopically assisted medial branch rhizotomy on the left side at L3, L4, and L5?

The operative note reads as follows:

"Stab incisions were created over the L3, L4, L5 transverse processes. An 18 gauge spinal needle was then directed fluoroscopically down to the transverse process. Direct palpitation was obtained with the needle. This was exchanged for a guide wire and then finally for a dilator and a cannula. The endoscope was inserted through each cannula.  Through the cannula the endoscope was used to visualize the transverse process and the soft tissue immediately superficial to the transverse process. The radiofrequency probe was used to ablate the soft tissue overlying the transverse process from the medial junction of the pars to the lateral tip. Both the medial and lateral branches of the nerve were visualizes and ablated using the radiofrequency probe. This was done at L3, L4, and L5."

Alaska Subscriber

Answer: To capture the additional work of the endoscopic-assisted procedure, this would best be reported as the unlisted code 64999 (Unlisted procedure, nervous system), as there is no code that describes performance of an endoscopically assisted rhizotomy.